Arthritic ankles; the NY Times asks if we can replace hips and knees, why not ankles?

Arthritic ankles; the NY Times asks if we can replace hips and knees, why not ankles?

The ankle joint is quite complicated in the way it moves. When we walk, it must flex (point your toes down), extend (point toes up), and rotate in and out and around for us to walk properly.

If the ankle becomes compromised due to a fracture, or a bad injury, often motion becomes restricted, affecting the way the leg moves. The foot and ankle are a huge part of what is known as the kinetic chain (series of joints from the ankle to the knee to the hip that affect movement domino style. To fully understand how this works, you must also include the joints, the fascia, the muscles and the ligaments, which affect and are affected by function and movement.

Back, hip and sacroiliac problems are often a result of foot postures that affect ankle movement which affects knee movement which then affects the movement of the hip and the sacroiliac joints. The reason gait asymmetries often is the cause of lower back pain is because of the compensations that occur up the kinetic or fasciokinetic (these joints always effect or are effected by the fascia surrounding those tissues) chain. Failure to consider gait in the process of evaluation lower back and sacroiliac problems then makes little sense, as the hips and spine are affected by the muscles and fascia that surrounds it.

The problem of ankle replacement becomes one of design, since there is such a variance in ankle joint types and quality and shapes. If you placed the wrong shape in the joint, it can destroy the knee and the hip as well as the lower back which will eventually also result in upper back and neck problems as well. Perhaps, this is why ankle joint replacement surgery is not as common or as popular as the idea of fusing the ankle entirely which is believed to relieve ankle pain, while unfortunately, it also puts the knee, hip and back at risk. You can read about ankle replacement surgery here.

What is the best solution? Rehabilitation and mobility should be maintained as long as possible. The question is how to do it and look at it. Do we use standard exercises and protocols on the ankle expecting a nice outcome? Based on years of experience, patients are not protocols so a healthcare practitioner must look at the limitations and tailor their care to that particular patients needs. From a chiropractic perspective, we will not only look at the ankle, but must look at the entire fasciokinetic chain including the back, since ankle stiffness will affect the musculoskeletal health of these areas as well due to compensation. Joint manipulation by a trained chiropractor has been shown to be both safe and effective, allowing improvements in mobility, reduced pain and when necessary, foot orthotics can be quite helpful in resolving problems with ankle joint motion.

While the article below does not mention the chiropractic approach, it has been my experience that often people can avoid unnecessary pain and surgery with better conservative management. Chiropractic sportsmedicine goes way beyond the spine and is often overlooked as a scientifically valid profession for the treatment of these types of problems.

Read the NY Times article here

Ask Well: Ankle Replacements

Q

People can replace hips and knees, so why not ankles?

I understand that because of the number of bones and complexity of the other interacting parts, ankles aren’t easy to repair back to their original condition, but how about just a ball socket replacement?

Asked by H. Porsche • 38 votes

A

“We can and do” replace ankles, said Dr. Steven Weinfeld, an orthopedic surgeon and chief of the foot and ankle service at the Icahn School of Medicine at Mount Sinai in New York City. While not nearly as common as surgeries to replace a worn-out hip or knee, ankle replacement is on the rise, with as many 25,000 replacements likely to be performed this year in the United States, according to estimates from the American Academy of Orthopedic Surgery. Like hip and knee replacements, the procedure treats debilitating bone-on-bone arthritis.

Until recently, though, the preferred surgical treatment for severely arthritic ankles had been a procedure called ankle fusion, in which rods are inserted into the ankle bones, fusing them and preventing them from grinding together. Ankle fusion generally eliminates arthritis pain, Dr. Weinfeld said, but it also warps how someone moves and can increase stress on knees and other leg joints